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4. Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction

Author

Kauw, Frans, Bennink, Edwin, de Jong, Hugo W. A. M., Kappelle, L. Jaap, Horsch, Alexander D., Velthuis, Birgitta K., Dankbaar, Jan W., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Nijeholt, Lycklama A. G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., Radiology & Nuclear Medicine, Neurology, Physics and medical technology, Radiology and nuclear medicine, VU University medical center, Dermatology, Surgery, Public and occupational health, Human genetics, Radiation Oncology, Amsterdam Neuroscience - Neurovascular Disorders, and ACS - Atherosclerosis & ischemic syndromes

Subjects
medicine.medical_specialty, Original Contributions, infarction, Clinical Sciences, Clinical Neurology, Infarction, Perfusion scanning, All institutes and research themes of the Radboud University Medical Center, Midline shift, Internal medicine, medicine.artery, Journal Article, Medicine, odds ratio, cardiovascular diseases, Advanced and Specialised Nursing, humans, Stroke, Advanced and Specialized Nursing, brain edema, middle cerebral artery, infarction, middle cerebral artery, Receiver operating characteristic, medicine.diagnostic_test, business.industry, Odds ratio, medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Angiography, Middle cerebral artery, Cardiology, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Neurology (clinical), prognosis, business, Cardiology and Cardiovascular Medicine, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Abstract

Supplemental Digital Content is available in the text., Background and Purpose— Predicting malignant middle cerebral artery (MCA) infarction can help to identify patients who may benefit from preventive decompressive surgery. We aimed to investigate the association between the ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) and malignant MCA infarction. Methods— Patients with an occlusion proximal to the M3 segment of the MCA were selected from the DUST (Dutch Acute Stroke Study). Admission imaging included noncontrast computed tomography (CT), CT perfusion, and CT angiography. Patient characteristics and CT findings were collected. The ratio of intracranial CSF volume to ICV (CSF/ICV) was quantified on admission thin-slice noncontrast CT. Malignant MCA infarction was defined as a midline shift of >5 mm on follow-up noncontrast CT, which was performed 3 days after the stroke or in case of clinical deterioration. To test the association between CSF/ICV and malignant MCA infarction, odds ratios and 95% CIs were calculated for 3 multivariable models by using binary logistic regression. Model performances were compared by using the likelihood ratio test. Results— Of the 286 included patients, 35 (12%) developed malignant MCA infarction. CSF/ICV was independently associated with malignant MCA infarction in 3 multivariable models: (1) with age and admission National Institutes of Health Stroke Scale (odds ratio, 3.3; 95% CI, 1.1–11.1), (2) with admission National Institutes of Health Stroke Scale and poor collateral score (odds ratio, 7.0; 95% CI, 2.6–21.3), and (3) with terminal internal carotid artery or proximal M1 occlusion and poor collateral score (odds ratio, 7.7; 95% CI, 2.8–23.9). The performance of model 1 (areas under the receiver operating characteristic curves, 0.795 versus 0.824; P=0.033), model 2 (areas under the receiver operating characteristic curves, 0.813 versus 0.850; P

Published
2019
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5. Circle of Willis variations in migraine patients with ischemic stroke

Author

Hamming, Arend M., van Walderveen, Marianne A. A., Mulder, Inge A., van der Schaaf, Irene C., Kappelle, L. Jaap, Velthuis, Birgitta K., Ferrari, Michel D., Terwindt, Gisela M., Visser, Marieke C., Schonewille, Wouter, Algra, Ale, Wermer, Marieke J. H., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., Lycklama a Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Luitse, M. J., van der Graaf, Y., Hamming, Arend M., van Walderveen, Marianne A. A., Mulder, Inge A., van der Schaaf, Irene C., Kappelle, L. Jaap, Velthuis, Birgitta K., Ferrari, Michel D., Terwindt, Gisela M., Visser, Marieke C., Schonewille, Wouter, Algra, Ale, Wermer, Marieke J. H., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., Lycklama a Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Luitse, M. J., and van der Graaf, Y.

Published
2019

6. Circle of Willis variations in migraine patients with ischemic stroke

Author

Circulatory Health, In Vivo NMR ISI, MS Radiologie, ZL Cerebrovasculaire Ziekten Medisch, Brain, Researchgr. Hart-brein as., JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Externen Hematologie, Affectieve & Psychotische Med., Cancer, Arts-Assistenten Onderwijs Radiologie, Arts-assistenten Radiologie, Onderzoek Beeld, ZL Algemene Neurologie Medisch, Opleiding Neurologie, Cardiovasculaire Epi Team 5, Hamming, Arend M., van Walderveen, Marianne A. A., Mulder, Inge A., van der Schaaf, Irene C., Kappelle, L. Jaap, Velthuis, Birgitta K., Ferrari, Michel D., Terwindt, Gisela M., Visser, Marieke C., Schonewille, Wouter, Algra, Ale, Wermer, Marieke J. H., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., Lycklama a Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Luitse, M. J., van der Graaf, Y., Circulatory Health, In Vivo NMR ISI, MS Radiologie, ZL Cerebrovasculaire Ziekten Medisch, Brain, Researchgr. Hart-brein as., JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Externen Hematologie, Affectieve & Psychotische Med., Cancer, Arts-Assistenten Onderwijs Radiologie, Arts-assistenten Radiologie, Onderzoek Beeld, ZL Algemene Neurologie Medisch, Opleiding Neurologie, Cardiovasculaire Epi Team 5, Hamming, Arend M., van Walderveen, Marianne A. A., Mulder, Inge A., van der Schaaf, Irene C., Kappelle, L. Jaap, Velthuis, Birgitta K., Ferrari, Michel D., Terwindt, Gisela M., Visser, Marieke C., Schonewille, Wouter, Algra, Ale, Wermer, Marieke J. H., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., Lycklama a Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Luitse, M. J., and van der Graaf, Y.

Published
2019

11. Risk factors for atherosclerotic and medial arterial calcification of the intracranial internal carotid artery

Author

Vos, Annelotte, Kockelkoren, Remko, de Vis, Jill B., van der Schouw, Yvonne T., van der Schaaf, I. C., Velthuis, B. K., Mali, W. P., de Jong, Pim A., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J.H., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Dankbaar, J. W., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., and the DUST study group

Subjects
Medial arterial calcification, Cardiovascular disease risk factors, Atherosclerosis, Intracranial carotid artery, Cardiology and Cardiovascular Medicine
Abstract

Background and aims: Calcifications of the intracranial internal carotid artery (iICA) are an important risk factor for stroke. The calcifications can occur both in the intimal and medial layer of the vascular wall. The aim of this study is to assess whether medial calcification in the iICA is differently related to risk factors for cardiovascular disease, compared to intimal calcification. Methods: Unenhanced thin slice computed tomography (CT) scans from 1132 patients from the Dutch acute stroke study cohort were assessed for dominant localization of calcification (medial or intimal) by one of three observers based on established methodology. Associations between known cardiovascular risk factors (age, gender, body mass index, pulse pressure, eGFR, smoking, hypertension, diabetes mellitus, hyperlipidemia, previous vascular disease, and family history) and the dominant localization of calcifications were assessed via logistic regression analysis. Results: In the 1132 patients (57% males, mean age 67.4 years [SD 13.8]), dominant intimal calcification was present in 30.9% and dominant medial calcification in 46.9%. In 10.5%, no calcification was seen. Age, pulse pressure and family history were risk factors for both types of calcification. Multivariably adjusted risk factors for dominant intimal calcification only were smoking (OR 2.09 [CI 1.27–3.44]) and hypertension (OR 2.09 [CI 1.29–3.40]) and for dominant medial calcification diabetes mellitus (OR 2.39 [CI 1.11–5.14]) and previous vascular disease (OR 2.20 [CI 1.30–3.75]). Conclusions: Risk factors are differently related to the dominant localizations of calcifications, a finding that supports the hypothesis that the intimal and medial calcification represents a distinct etiology.

Published
2018

12. Risk factors for atherosclerotic and medial arterial calcification of the intracranial internal carotid artery

Author

AvL-U, Circulatory Health, Onderzoek Beeld, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Radiologie, Researchgr. Hart-brein as., Brain, Cancer, Researchgr. Systems Radiology, Infection & Immunity, Public Health Practice, Externen Hematologie, Affectieve & Psychotische Med., Pathologie Pathologen staf, Arts-Assistenten Onderwijs Radiologie, ZL Algemene Neurologie Medisch, ZL Cerebrovasculaire Ziekten Medisch, Opleiding Neurologie, Vos, Annelotte, Kockelkoren, Remko, de Vis, Jill B., van der Schouw, Yvonne T., van der Schaaf, I. C., Velthuis, B. K., Mali, W. P., de Jong, Pim A., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J.H., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Dankbaar, J. W., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., the DUST study group, AvL-U, Circulatory Health, Onderzoek Beeld, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Radiologie, Researchgr. Hart-brein as., Brain, Cancer, Researchgr. Systems Radiology, Infection & Immunity, Public Health Practice, Externen Hematologie, Affectieve & Psychotische Med., Pathologie Pathologen staf, Arts-Assistenten Onderwijs Radiologie, ZL Algemene Neurologie Medisch, ZL Cerebrovasculaire Ziekten Medisch, Opleiding Neurologie, Vos, Annelotte, Kockelkoren, Remko, de Vis, Jill B., van der Schouw, Yvonne T., van der Schaaf, I. C., Velthuis, B. K., Mali, W. P., de Jong, Pim A., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J.H., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Dankbaar, J. W., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., and the DUST study group

Published
2018

13. Predicting the presence of macrovascular causes in non-traumatic intracerebral haemorrhage: the DIAGRAM prediction score

Author

Hilkens, Nina A., van Asch, Charlotte J. J., Werring, David J., Wilson, Duncan, Rinkel, Gabriël J. E., Algra, Ale, Velthuis, Birgitta K., de Kort, G. rard A. P., Witkamp, Theo D., van Nieuwenhuizen, Koen M., de Leeuw, Frank-Erik, Schonewille, Wouter J., de Kort, Paul L. M., Dippel, Diederik W. J., Raaymakers, Theodora W. M., Hofmeijer, Jeannette, Wermer, Marieke J. H., Kerkhoff, Henk, Jellema, Korné, Bronner, Irene M., Remmers, Michel J. M., Bienfait, Henri Paul, Witjes, Ron J. G. M., Jäger, H. Rolf, Greving, Jacoba P., Klijn, Catharina J. M., Boogaarts, H. B., van Dijk, E. J., Schonewille, W. J., Pellikaan, W. M. J., Puppels-de Waard, C., de Kort, P. L. M., Peluso, J. P., van Tuijl, J. H., Hofmeijer, J., Joosten, F. B. M., Dippel, D. W., Khajeh, L., Raaijmakers, T. W. M., Wermer, M. J., van Walderveen, M. A., Kerkhoff, H., Zock, E., Jellema, K., Lycklama, G. J., Bronner, I. M., Remmers, M. J. M., Witjes, R. J. G. M., Bienfait, H. P., Droogh-Greve, K. E., Donders, R. C. J. M., Kwa, V. I. H., Schreuder, T. H., Franke, C. L., Straver, J. S., Jansen, C., Bakker, S. L. M., Pleiter, C. C., Visser, M. C., van Asch, C. J. J., Velthuis, B. K., Rinkel, G. J. E., van Nieuwenhuizen, K. M., Klijn, C. J. M., Neurology, and Amsterdam Neuroscience - Neurovascular Disorders

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Computed Tomography Angiography, Clinical Neurology, Logistic regression, Magnetic resonance angiography, 03 medical and health sciences, Young Adult, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Predictive Value of Tests, Risk Factors, Internal medicine, Non traumatic, medicine, Humans, 030212 general & internal medicine, cardiovascular diseases, Prospective Studies, Aged, Cerebral Hemorrhage, Netherlands, Central Nervous System Vascular Malformations, Prediction score, medicine.diagnostic_test, business.industry, Arteriovenous malformation, Digital subtraction angiography, Middle Aged, medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], nervous system diseases, Cerebral Angiography, Psychiatry and Mental health, Logistic Models, Cohort, Angiography, Cardiology, Surgery, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, Magnetic Resonance Angiography
Abstract

ObjectiveA substantial part of non-traumatic intracerebral haemorrhages (ICH) arises from a macrovascular cause, but there is little guidance on selection of patients for additional diagnostic work-up. We aimed to develop and externally validate a model for predicting the probability of a macrovascular cause in patients with non-traumatic ICH.MethodsThe DIagnostic AngioGRAphy to find vascular Malformations (DIAGRAM) study (n=298; 69 macrovascular cause; 23%) is a prospective, multicentre study assessing yield and accuracy of CT angiography (CTA), MRI/ magnetic resonance angiography (MRA) and intra-arterial catheter angiography in diagnosing macrovascular causes in patients with non-traumatic ICH. We considered prespecified patient and ICH characteristics in multivariable logistic regression analyses as predictors for a macrovascular cause. We combined independent predictors in a model, which we validated in an external cohort of 173 patients with ICH (78 macrovascular cause, 45%).ResultsIndependent predictors were younger age, lobar or posterior fossa (vs deep) location of ICH, and absence of small vessel disease (SVD). A model that combined these predictors showed good performance in the development data (c-statistic 0.83; 95% CI 0.78 to 0.88) and moderate performance in external validation (c-statistic 0.66; 95% CI 0.58 to 0.74). When CTA results were added, the c-statistic was excellent (0.91; 95% CI 0.88 to 0.94) and good after external validation (0.88; 95% CI 0.83 to 0.94). Predicted probabilities varied from 1% in patients aged 51–70 years with deep ICH and SVD, to more than 50% in patients aged 18–50 years with lobar or posterior fossa ICH without SVD.ConclusionThe DIAGRAM scores help to predict the probability of a macrovascular cause in patients with non-traumatic ICH based on age, ICH location, SVD and CTA.

Published
2017
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14. Temporal profile of body temperature in acute ischemic stroke: Relation to infarct size and outcome

Author

Geurts, Marjolein, Scheijmans, Féline E.V., van Seeters, Tom, Biessels, Geert Jan, Kappelle, L. Jaap, Velthuis, Birgitta K., van der Worp, H. Bart, Majoie, C.B., Roos, Y.B., Duijm, L.E., Keizer, K., van der Lugt, A., Dippel, D.W., Greve, Droogh de, Bienfait, H.P., van Walderveen, Marianne A. A., Wermer, M.J., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D.A., Kwa, V.I.H., Meijer, Frederick J. A., van Dijk, E. J., Kesselring, F.O., Hofmeijer, J., Vos, J. A., Schonewille, Wouter J., van Rooij, W.J.J., de Kort, P.L., Pleiter, C. Constantijn, Bakker, S. L., Bot, J., Visser, M. C., van der Schaaf, Irene C., Dankbaar, J.W., Mali, W.P., van Seeters, T., Horsch, Alexander D., Niesten, Joris M., Biessels, G.J., Luitse, M.J., van der Graaf, Y., Radiology and Nuclear Medicine, ANS - Neurovascular Disorders, ACS - Microcirculation, Neurology, ACS - Atherosclerosis & ischemic syndromes, Public and occupational health, Molecular cell biology and Immunology, Radiology and nuclear medicine, and Pathology

Subjects
Male, medicine.medical_specialty, Time Factors, Neurology, Clinical Neurology, Hypothermia, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Hypothermia, Induced, Modified Rankin Scale, Journal Article, medicine, Humans, Body temperature, cardiovascular diseases, Stroke, Aged, medicine.diagnostic_test, business.industry, Cerebral infarction, Magnetic resonance imaging, Recovery of Function, General Medicine, Prognosis, medicine.disease, Magnetic Resonance Imaging, Confidence interval, Relative risk, Anesthesia, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, Research Article
Abstract

Background: High body temperatures after ischemic stroke have been associated with larger infarct size, but the temporal profile of this relation is unknown. We assess the relation between temporal profile of body temperature and infarct size and functional outcome in patients with acute ischemic stroke. Methods: In 419 patients with acute ischemic stroke we assessed the relation between body temperature on admission and during the first 3 days with both infarct size and functional outcome. Infarct size was measured in milliliters on CT or MRI after 3 days. Poor functional outcome was defined as a modified Rankin Scale score ≥3 at 3 months. Results: Body temperature on admission was not associated with infarct size or poor outcome in adjusted analyses. By contrast, each additional 1.0 °C in body temperature on day 1 was associated with 0.31 ml larger infarct size (95% confidence interval (CI) 0.04-0.59), on day 2 with 1.13 ml larger infarct size(95% CI, 0.83-1.43), and on day 3 with 0.80 ml larger infarct size (95% CI, 0.48-1.12), in adjusted linear regression analyses. Higher peak body temperatures on days two and three were also associated with poor outcome (adjusted relative risks per additional 1.0 °C in body temperature, 1.52 (95% CI, 1.17-1.99) and 1.47 (95% CI, 1.22-1.77), respectively). Conclusions: Higher peak body temperatures during the first days after ischemic stroke, rather than on admission, are associated with larger infarct size and poor functional outcome. This suggests that prevention of high temperatures may improve outcome if continued for at least 3 days.

Published
2016
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15. Temporal profile of body temperature in acute ischemic stroke: Relation to infarct size and outcome

Author

Opleiding Neurologie, Brain, Arts-assistenten Radiologie, ZL Algemene Neurologie Medisch, Circulatory Health, ZL Cerebrovasculaire Ziekten Medisch, MS Radiologie, Cancer, Onderzoek Beeld, Cardiovasculaire Epi Team 7, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Geurts, Marjolein, Scheijmans, Féline E V, van Seeters, Tom, Biessels, Geert J., Kappelle, L. Jaap, Velthuis, Birgitta K., van der Worp, H. Bart, Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Greve, Droogh de, Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., Opleiding Neurologie, Brain, Arts-assistenten Radiologie, ZL Algemene Neurologie Medisch, Circulatory Health, ZL Cerebrovasculaire Ziekten Medisch, MS Radiologie, Cancer, Onderzoek Beeld, Cardiovasculaire Epi Team 7, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Geurts, Marjolein, Scheijmans, Féline E V, van Seeters, Tom, Biessels, Geert J., Kappelle, L. Jaap, Velthuis, Birgitta K., van der Worp, H. Bart, Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Greve, Droogh de, Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., and van der Graaf, Y.

Published
2016

16. Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol

Author

Van Seeters, Tom, Biessels, Geert J., van der Schaaf, Irene C., Dankbaar, Jan W., Horsch, Alexander D., Luitse, Merel J.A., Niesten, Joris M., Mali, Willem P.T.M., Kappelle, L. J., van der Graaf, Yolanda, Velthuis, Birgitta K., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Lycklamaà Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, Neurology, Public Health, Radiology and nuclear medicine, and Public and occupational health

Subjects
medicine.medical_specialty, Infarct, Clinical Neurology, Perfusion scanning, Ischaemia, Brain Ischemia, Cohort Studies, Study Protocol, Modified Rankin Scale, Predictive Value of Tests, medicine, Humans, Prospective Studies, Stage (cooking), Prospective cohort study, Stroke, Netherlands, Receiver operating characteristic, medicine.diagnostic_test, business.industry, General Medicine, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, Cerebral Angiography, Perfusion, Treatment Outcome, CT angiography, Predictive value of tests, Angiography, CT perfusion, Neurology (clinical), Radiology, business, Prediction, Tomography, X-Ray Computed, Follow-Up Studies
Abstract

Contains fulltext : 136571.pdf (Publisher’s version ) (Open Access) BACKGROUND: Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We present the study protocol of the Dutch acute Stroke Trial (DUST). The DUST aims to assess the prognostic value of CT perfusion and CT angiography in predicting stroke outcome, in addition to patient characteristics and non-contrast CT. For this purpose, individualised prediction models for clinical outcome after stroke based on the best predictors from patient characteristics and CT imaging will be developed and validated. METHODS/DESIGN: The DUST is a prospective multi-centre cohort study in 1500 patients with suspected acute ischaemic stroke. All patients undergo non-contrast CT, CT perfusion and CT angiography within 9 hours after onset of the neurological deficits, and, if possible, follow-up imaging after 3 days. The primary outcome is a dichotomised score on the modified Rankin Scale, assessed at 90 days. A score of 0-2 represents good outcome, and a score of 3-6 represents poor outcome. Three logistic regression models will be developed, including patient characteristics and non-contrast CT (model A), with addition of CT angiography (model B), and CT perfusion parameters (model C). Model derivation will be performed in 60% of the study population, and model validation in the remaining 40% of the patients. Additional prognostic value of the models will be determined with the area under the curve (AUC) from the receiver operating characteristic (ROC) curve, calibration plots, assessment of goodness-of-fit, and likelihood ratio tests. DISCUSSION: This study will provide insight in the added prognostic value of CTP and CTA parameters in outcome prediction of acute stroke patients. The prediction models that will be developed in this study may help guide future treatment decisions in the acute stage of ischaemic stroke.

Published
2014
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17. Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial

Author

Zinkstok, Sanne M., Roos, Yvo B., Aerden, L. A. M., van den Berg-Vos, R. M., Bakker, S. L. M., Bienfait, H. M. E., Bienfait, H. P., Boon, A. E., Brans, J. W. M., Bronner, I. M., de Bruijn, S. F. T. M., Franke, C. L., Hofstee, D. J., Jansen, B. P. W., Jellema, K., Kalkers, N. F., Portegies, P., Keizer, K., Kerkhoff, H., de Gans, K., Kloos, L. M. H., Kok, A. J. M., de Kort, P. L. M., de Kruijk, J. R., van der Kruijk, R. A., Kwa, V. I. H., Kruyt, N. D., Meijer, R. J., van der Meulen, W. D. M., Mulleners, W. M., Nederkoorn, P. J., van der Ree, T. C., Rooyer, F. A., Saxena, R., Schuiling, W. J., Verbiest, H. B. C., Verhey, J. C. B., Vermeer, S. E., Visée, H. F., Visser, M. C., van der Wiel, H. L., van der Worp, H. B., de Haan, R. J., Stam, J., Vermeulen, M., Peters, R. J. G., Majoie, C. B. L. M., Beenen, L. F., Marquering, H. A., van Geloven, N., Epidemiologie, MUMC+: KIO Kemta (9), RS: CAPHRI School for Public Health and Primary Care, Neurology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Other departments, APH - Amsterdam Public Health, Clinical Research Unit, Cardiology, Radiology and Nuclear Medicine, Other Research, and Biomedical Engineering and Physics

Subjects
Male, medicine.medical_specialty, Time Factors, Drug Administration Schedule, law.invention, Fibrinolytic Agents, Randomized controlled trial, Modified Rankin Scale, law, Internal medicine, Secondary Prevention, medicine, Clinical endpoint, Humans, Prospective Studies, Platelet activation, Infusions, Intravenous, Stroke, Aged, Aged, 80 and over, Aspirin, business.industry, Standard treatment, General Medicine, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Tissue Plasminogen Activator, Early Termination of Clinical Trials, Platelet aggregation inhibitor, Drug Therapy, Combination, Female, business, Intracranial Hemorrhages, Platelet Aggregation Inhibitors, medicine.drug
Abstract

Summary Background Thrombolysis with intravenous alteplase is the only approved treatment for acute ischaemic stroke. After alteplase-induced recanalisation, reocclusion occurs in 14–34% of patients, probably because of platelet activation. Early administration of antiplatelet therapy after alteplase could reduce the risk of reocclusion and improve outcome. We compared the effects of early addition of intravenous aspirin to alteplase with standard alteplase without aspirin. Methods In this multicentre, randomised, open-label trial with blind-endpoint assessment, patients with acute ischaemic stroke treated with alteplase were randomly assigned to 300 mg intravenous aspirin within 90 min after start of alteplase treatment or to no additional treatment. In both groups, oral antiplatelet therapy was started 24 h after alteplase treatment. The primary endpoint was favourable outcome, defined as a score of 0–2 on the modified Rankin scale at 3 months. This trial is registered with the Netherlands Trial Register (NTR822). Findings Between July 29, 2008, and April 20, 2011, 642 patients (322 patients aspirin, 320 patients standard treatment) of the targeted 800 patients were enrolled. At that time, the trial was terminated prematurely because of an excess of symptomatic intracranial haemorrhage (SICH) and no evidence of benefit in the aspirin group. At 3 months, 174 (54·0%) patients in the aspirin group versus 183 (57·2%) patients in the standard treatment group had a favourable outcome (absolute difference −3·2%, 95% CI −10·8 to 4·2; crude relative risk 0·94, 0·82 to 1·09, p=0·42). Adjusted odds ratio was 0·91 (95% CI 0·66–1·26, p=0·58). SICH occurred more often in the aspirin group (14 [4·3%] patients) than in the standard treatment group (five [1·6%]; absolute difference 2·8%, 95% CI 0·2–5·4; p=0·04). SICH was more often the cause of poor outcome in the aspirin group compared with the standard treatment group (11 vs 1, p=0·006). Interpretation Early administration of intravenous aspirin in patients with acute ischaemic stroke treated with alteplase does not improve outcome at 3 months and increases the risk of SICH. The results of this trial do not support a change of the current guidelines, which advise to start antiplatelet therapy 24 h after alteplase. Funding The Dutch Heart Foundation.

Published
2012

18. PATCH: platelet transfusion in cerebral haemorrhage: study protocol for a multicentre, randomised, controlled trial

Author

de Gans, Koen, de Haan, Rob J., Majoie, Charles B., Koopman, Maria M., Brand, Anneke, Dijkgraaf, Marcel G., Vermeulen, Marinus, Roos, Yvo B., Hofmeijer, J., Vermeer, S. E., Franke, C. L., Mulleners, W. M., Keizer, K., Dijkstra, U. J., van Kooten, F., Bronner, I. M., Kloos, L. M. H., Viseé, H. F., de Bruijn, S. F. T. M., Bienfait, H. M. E., Saxena, R., Meilof, J. F., Raaijmakers, T. W. M., Brans, J. W. M., Jellema, K., Schuiling, W. J., Portegies, P., Rooyer, F. A., Aerden, L. A. M., van der Meulen, W. D. M., de Kruijk, J. R., Jansen, B. P. W., Kwa, V. I. H., Meijer, R. J., Boon, A. E., Schonewille, W. J., de Kort, P. L. M., Bakker, S. L. M., Hofstee, D. J., van den Berg-Vos, R. M., van Dijk, E. J., Klijn, C. J. M., Verhey, J. C. B., Visser, M. C., van der Ree, T. C., Reitsma, J. B., Kamphuisen, P. W., Klijn, C. J., Zinkstok, S. M., Faculteit der Geneeskunde, Amsterdam Cardiovascular Sciences, Amsterdam Neuroscience, Neurology, Amsterdam Public Health, Clinical Research Unit, Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Epidemiology and Data Science, Other departments, Amsterdam institute for Infection and Immunity, and Vascular Medicine

Subjects
medicine.medical_specialty, Neurology, Time Factors, Clinical Neurology, Platelet Transfusion, lcsh:RC346-429, law.invention, Randomized controlled trial, Clinical Protocols, law, Study protocol, medicine, Humans, Neurochemistry, cardiovascular diseases, Prospective Studies, Prospective cohort study, lcsh:Neurology. Diseases of the nervous system, Cerebral Hemorrhage, business.industry, Brain, General Medicine, Clopidogrel, Surgery, Platelet transfusion, Treatment Outcome, Research Design, Anesthesia, Acute Disease, Platelet aggregation inhibitor, Neurology (clinical), Neurosurgery, business, Platelet Aggregation Inhibitors, medicine.drug, Follow-Up Studies
Abstract

Background Patients suffering from intracerebral haemorrhage have a poor prognosis, especially if they are using antiplatelet therapy. Currently, no effective acute treatment option for intracerebral haemorrhage exists. Limiting the early growth of intracerebral haemorrhage volume which continues the first hours after admission seems a promising strategy. Because intracerebral haemorrhage patients who are on antiplatelet therapy have been shown to be particularly at risk of early haematoma growth, platelet transfusion may have a beneficial effect. Methods/Design The primary objective is to investigate whether platelet transfusion improves outcome in intracerebral haemorrhage patients who are on antiplatelet treatment. The PATCH study is a prospective, randomised, multi-centre study with open treatment and blind endpoint evaluation. Patients will be randomised to receive platelet transfusion within six hours or standard care. The primary endpoint is functional health after three months. The main secondary endpoints are safety of platelet transfusion and the occurrence of haematoma growth. To detect an absolute poor outcome reduction of 20%, a total of 190 patients will be included. Discussion To our knowledge this is the first randomised controlled trial of platelet transfusion for an acute haemorrhagic disease. Trial registration The Netherlands National Trial Register (NTR1303)

Published
2010

20. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: A randomised, observer-blind, controlled clinical trial [ISRCTN 71598245].

Author

Oedit, R., van Kooten, F., Bakker, S. L. M., and Dippel, D. W. J.

Subjects
LUMBAR puncture, THERAPEUTICS, HEADACHE, PATIENTS, RANDOMIZED controlled trials
Abstract

Background: Post dural punction headache (PDPH) occurs in 10% to 40% of the patients who had a lumbar puncture. Its symptoms can be severe and incapacitating. The epidural blood patch is widely accepted as the treatment of choice for postdural puncture headache. Uncontrolled studies report rapid recovery after patching in 90% to 100% of treated patients. However, sufficient evidence from randomised, controlled clinical trials is lacking. Methods: BLOPP (blood patch for post dural puncture headache) is a randomised, single centre, observer-blind clinical trial. Patients with PDPH for at least 24 hours and at most 7 days after lumbar puncture will be randomised to treatment with an epidural blood patch (EDBP) or to conventional treatment, i.e. 24 hours bed rest and ample fluid intake. PDPH 24 hours after treatment, classified on a 4-point scale (no, mild, moderate, severe) is the primary outcome. The secondary outcome is the presence of PDPH 7 days after treatment. We estimated that a sample size of 2 × 20 patients would provide us with a power of 80% to detect a relative reduction in number of patients with persisting PDPH after 24 hours of 50% at the usual significance level α = 5%, taking into account that in approximately 10% of the patients the PDPH will have resolved spontaneously after one day. Discussion: The EDBP is accepted as the treatment of choice for PDPH although randomised, controlled data is scarce. Our randomised, observer-blind clinical trial enables us to compare the efficacy of two clinically practiced methods of PDPH treatment; EDBP versus conventional treatment, as they are applied in clinical practise. [ABSTRACT FROM AUTHOR]

Published
2005
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23. Cerebral CO2reactivity, cholesterol, and high-density lipoprotein cholesterol in the elderly

Author

Bakker, S. L. M., de Leeuw, F.-E., Koudstaal, P. J., Hofman, A., and Breteler, M. M. B.

Abstract

Cholesterol and its subfractions play a role in the development of atherosclerosis. Cerebral CO2reactivity reflects the compensatory capacity of cerebral arterioles. The authors investigated the relationship between total cholesterol, high-density lipoprotein (HDL), their ratio, and cerebral CO2reactivity in 826 participants from the Rotterdam Study. Cerebral CO2reactivity increased significantly with increasing levels of HDL and decreased significantly with an increasing total cholesterol/HDL ratio. This suggests that blood lipids may also affect smaller cerebral blood vessels.

Published
2000

24. [Spinal cord injury after a fall in patients with cervical spinal canal stenosis].

Author

Taha A and Bakker SLM

Subjects
Aged, Humans, Male, Accidental Falls, Cervical Vertebrae injuries, Spinal Cord Compression etiology, Spinal Cord Injuries etiology, Spinal Stenosis complications
Abstract

In patients with pre-existent cervical spinal canal stenosis, minimal trauma, leading to neck hyperextension, can cause a significant increase of spinal cord compression. However, spinal cord injury is generally associated with major trauma and is usually not expected in patients with minor trauma. The resulting symptoms are diverse, making it even more difficult to diagnose. To illustrate the variety in symptoms at presentation, we describe two male patients aged 66 and 69. Rapid diagnosis is important as acute neurosurgical intervention may be indicated. Physical neurological examination, and in particular testing peripheral reflexes, can contribute to the rapid diagnosis of spinal cord injury. Cervical spine CT should not only be assessed for acute traumatic injury, but also for possible stenosis of the cervical spinal canal.

Published
2018

25. [Intracranial hypertension with severe and irreversible reduced acuity and impaired visual fields after oral tetracycline].

Author

Altinbas A, Hoogstede HA, and Bakker SL

Subjects
Administration, Oral, Adult, Female, Humans, Intracranial Pressure, Papilledema chemically induced, Papilledema therapy, Recurrence, Tetracycline therapeutic use, Treatment Outcome, Visual Acuity drug effects, Visual Fields drug effects, Acetazolamide therapeutic use, Diuretics therapeutic use, Intracranial Hypertension chemically induced, Intracranial Hypertension therapy, Spinal Puncture, Tetracycline adverse effects
Abstract

A young, non-obese woman aged 24 years with normal blood pressure developed intracranial hypertension after the oral use of tetracycline. Neuro-ophthalmologic examination revealed severely reduced acuity, papilledema, and concentric impaired visual fields. She was treated with acetazolamide and recurrent lumbar punctures and recovered, but without improvement in either acuity or visual fields. Intracranial hypertension is a fairly rare disease characterised by increased intracranial pressure without structural abnormalities in the brain or hydrocephalus, and is termed idiopathic in the absence of an underlying cause. Tetracycline should be considered as a cause of intracranial hypertension if a patient complains of previously unknown headache a few days after its ingestion. Headache and the presence of bilateral papilledema, decreased visual acuity and visual-field defects are indications for urgent referral to a neurologist. Therapy consists of a combination of repetitive lumbar punctures and medication. Surgical interventions include lumboperitoneal shunting and optic nerve fenestration. Intracranial hypertension may lead to irreversible decreased visual acuity and visual-field defects resulting in disability.

Published
2005

26. [Irreversible coma following hypoglycemia in Sheehan syndrome with adrenocortical insufficiency].

Author

Sas AM, Meynaar IA, Laven JS, Bakker SL, and Feelders RA

Subjects
Adrenal Insufficiency drug therapy, Adult, Blood Glucose metabolism, Fatal Outcome, Female, Glucocorticoids therapeutic use, Humans, Hypoglycemia drug therapy, Hypopituitarism drug therapy, Hysterectomy, Postpartum Hemorrhage complications, Postpartum Hemorrhage etiology, Prednisone therapeutic use, Pregnancy, Shock etiology, Shock surgery, Adrenal Insufficiency complications, Coma etiology, Hypoglycemia complications, Hypopituitarism complications, Postpartum Hemorrhage surgery
Abstract

A 24-year-old woman of Somali origin delivered at term after an uncomplicated pregnancy. Post-partum haemorrhage resulted in hypovolaemic shock which was treated by hysterectomy. Five days later she became comatose due to unrecognised hypoglycaemia which caused severe irreversible brain damage and status epilepticus. Treatment in the intensive care unit with artificial respiration, prednisolone, desmopressin, inotropic support, barbiturates and an anaesthetic under EEG guidance was unsuccessful. The patient died 28 days post-partum. The hypoglycaemia was due to a combination of (a) inadequate glucose intake and (b) lack of counter-regulatory mechanisms due to a deficiency of steroids and growth hormone as a result of loss of pituitary function (Sheehan syndrome) together with adrenocortical insufficiency. The combination of Sheehan syndrome and primary adrenocortical insufficiency has not been described previously in the literature.

Published
2003

27. Right temporal lobe glioblastoma presenting in the left orbit. Case report.

Author

Kros JM, van den Berge H, Tanghe HL, and Bakker SL

Subjects
Brain Neoplasms radiotherapy, Epilepsy, Generalized diagnosis, Fatal Outcome, Glioblastoma radiotherapy, Humans, Intracranial Hypertension diagnosis, Male, Middle Aged, Neoplasm Invasiveness, Orbital Neoplasms radiotherapy, Skull Base Neoplasms pathology, Subarachnoid Space pathology, Brain Neoplasms diagnosis, Glioblastoma diagnosis, Orbital Neoplasms diagnosis, Temporal Lobe pathology
Abstract

Dissemination of gliomas outside the central nervous system without preceding neurosurgery is a rare phenomenon. Glial neoplasms presenting as bone lesions are even more rare. A case of glioblastoma multiforme (GBM) with initial presentation in the orbit following a single generalized seizure is described. Signs of intracranial hypertension resulted from subarachnoid tumor invasion. The patient was treated with whole-dose radiation therapy but survived for only 6 months following the initial presentation. An autopsy revealed a right temporal GBM with extensive subarachnoid spread and invasion in the left orbit and skull base. The literature on dissemination of primary tumors of the brain is reviewed.

Published
2000
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28. Intracranial high-intensity transient signals after homograft or mechanical aortic valve replacement.

Author

Lievense AM, Bakker SL, Dippel DW, Taams MA, Koudstaal PJ, and Bogers AJ

Subjects
Adult, Aged, Aged, 80 and over, Aortic Valve transplantation, Blood Flow Velocity, Brain blood supply, Cerebral Arteries diagnostic imaging, Cerebrovascular Circulation, Female, Follow-Up Studies, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases surgery, Humans, Intracranial Embolism and Thrombosis diagnostic imaging, Intracranial Embolism and Thrombosis etiology, Male, Middle Aged, Transplantation, Homologous adverse effects, Ultrasonography, Doppler, Transcranial, Aortic Valve surgery, Biocompatible Materials adverse effects, Brain physiopathology, Heart Valve Prosthesis adverse effects, Intracranial Embolism and Thrombosis physiopathology
Abstract

Objective: Comparison of the occurrence, intensity and rate of high-intensity transient signals (HITS), measured in both middle cerebral arteries by transcranial Doppler ultrasound (TCD) after mechanical or homograft aortic valve implantation., Experimental Design: TCD monitoring was performed by means of a pulsed Doppler ultrasound with two 2 MHz probes, stabilized on the head and directed at the middle cerebral artery., Setting: Outdoor patients after aortic valve replacement in a university hospital., Patients: The study cohort comprised a random transverse sample of patients and included 20 patients with a mechanical aortic valve and 20 with a homograft aortic valve. Comparisons were made with 20 admitted control patients., Interventions: No interventions., Measures: No significant number of HITS were expected in the homograft group and a limited number in the mechanical valve group., Results: HITS were detected in more patients after implantation of a mechanical aortic valve prosthesis compared with a homograft aortic valve (16 versus 8, p=0.02). Nevertheless, more patients with a homograft aortic valve showed HITS than the control patients (8 versus 1, p=0.02). The mean number of HITS in the mechanical prosthesis group was higher than in the homograft group (3, range 0-18 versus 13, range 0-70, p<0.05). HITS in patients with mechanical prostheses had a higher amplitude than HITS in patients with homograft aortic valves (p<0.0001). Focal neurological deficit (FND) was diagnosed in 9 patients (mechanical prosthesis 6 versus homograft 3, ns)., Conclusions: HITS commonly occur both in patients with a mechanical aortic valve and in patients with a homograft aortic valve. HITS occur significantly less often, at a lower rate and with a lower intensity in patients with homograft aortic valve compared with patients with a mechanical aortic valve. Future studies should elucidate the nature and prognostic significance of HITS and their relationship with thromboembolic events.

Published
1998

29. [Central spinal cord syndrome].

Author

Bakker SL, Kamphuis DJ, and Rico RE

Subjects
Adolescent, Adult, Cervical Vertebrae injuries, Child, Humans, Middle Aged, Spinal Cord Injuries physiopathology, Spinal Cord Injuries therapy, Syndrome, Spinal Cord Injuries diagnosis
Published
1993

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